PEPITO, RICA ALYSSA M.

UNIVERSITY OF CEBU SCHOOL OF MEDICINE Source: Harrison’s Principles of Internal Medicine 20 th Edition

Cancer of the Skin (Ch. 72)

Nonmelanoma Skin
Melanoma
Cancer (NMSC)

Prevention and Clinical Prognostic Basal cell Squamous cell

Risk Factors Diagnostics SLNB Treatment
early detection classifications factors carcinoma carcinoma

Sunscreen
neural crest Best predictor of
Presence of Nevi (atleast SPF 30), Excisional biopsy Superficial
derived, usually For tumors >1 metastatic risk = Premalignant
(>40 melanocytic protective with 1- to 3-mm spreading M, Stage 1/2: Wide Subtypes Treatment Prevention Treatment Prevention
affects white- mm thick or Breslow Significant cause p53 and N-RAS forms
nevi; congenital clothing, tanning margins Lentigo maligna local excision,
skinned, M>F, thickness is UV radiation, electrodesiccatio active commonly
melanocytic nevi cessation (below) M, Acral SLNB
late 50s Monitoring of Incisional biopsy hedgehog n and curettage surveillance, affected; dotted
- small (≤1.5 cm)/ for large lesions lentiginous M: pathway, PTCH1 Superficial BCC - (ED&C) - most Synthetic Keratoacanthom
suspicious Anatomic site of or coiled vessels
medium (1.5–20 or lesions on the radial growth mutation, slowly erythematous common for retinoid, topical a - low grade,
lesions (ABCDE): Melanomas primary lesion are a hallmark of
cm)/giant (>20 face, hands, and enlarging, locally scaling plaques superficial, 5-FU, imiquimod, fast active
asymmetry, 0.76–1.0 mm (favorable: SCC when Surgery and/or
cm) feet invasive, higher on trunks and minimally ingenol surveillance,
border thick, with high- forearm and leg Stage 3: Surgery, viewed through a RT (LN
risk in the face, proximal Wide local
invasive mebutate dermatoscope metastasis), synthetic
irregularity, color risk features (excluding the Immunotherapy,
Fluorescence in Nodular M: ears, or scalp extremities excision - for Actinic retinoid, topical
variegation, (ulceration, high feet); BCG, RT, IFN-a2b, Cisplatin, 5-FU,
situ hybridization vertical growth; invasive, keratoses/cheiliti 5-FU, imiquimod,
Personal and diameter >6 mm, mitotic index, or unfavorable: Imiquimod, Cetuximab
(FISH) early metastasis aggressive s - premalignant (advanced ingenol
Family History evolving (any lymphovascular scalp, hands, Talimogene MMStumors
(best for
Nodular BCC - disease) mebutate
change in size, invasion); wide feet, and mucous tissue
shape, color, or Comparative excision alone is membranes) pearly nodule,
preservation), Bowen's disease -
elevation or new genome the usual rolled borders,
Vismodegib/Soni intraepithelial
Light skin symptoms such hybridization definitive Desmoplastic M: central crust
Stage 4: degib (metastatic form
as bleeding, (CGH) therapy fibrotic response,
Age Metastasectomy, or advanced BCC
itching, and Labs - CBC, neural invasion, that recurred)
clinically Ipilimumab,
crusting) Complete local recurrence
negative lymph Nivolumab, Pigmented BCC -
Sun exposure metabolic panel, Pembrolizumab,
nodes - SLNB presence of
LDH Vemurafenib, melanin
Dabrafenib,
Trametinib,
Imaging - CT, PET Cobitenib,
Older age Talimogene, Morpheaform
Chemotherapy (fibrosing),
infiltrative, and
micronodular
BCC: most
Genetic
invasive,
Susceptibility
potentially
(CDKN2A germ
aggressive
line or MC1R
gene mutations)